Healthcare Provider Details

I. General information

NPI: 1609891779
Provider Name (Legal Business Name): SUZANNE SUNDHEIM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 WALNUT ST SUITE 106
BOULDER CO
80302-5751
US

IV. Provider business mailing address

2501 WALNUT ST SUITE 106
BOULDER CO
80302-5751
US

V. Phone/Fax

Practice location:
  • Phone: 303-786-7430
  • Fax: 303-443-4682
Mailing address:
  • Phone: 303-786-7430
  • Fax: 303-443-4682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number33134
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier01-331347
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer
# 2
Identifier33134
Identifier TypeOTHER
Identifier StateCO
Identifier IssuerCO LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: